title: Cushing syndrome due to surreptitious glucocorticoid administration.
abstract: We report a case of subtle Cushing syndrome in a Pakistani man who self-treated his asthma with a potent long-acting oral glucocorticoid (betamethasone disodium phosphate [Bentelan]) for more than 30 years. He presented with cushingoid features, insulin resistance, and refractory hypertension. Laboratory evaluation revealed undetectable cortisol levels and suppression of the hypothalamic-pituitary-adrenal axis. The patient obtained the drug from his country of origin, with no understanding of the potential adverse effects imposed by long-term use of steroids. He is now being slowly weaned off the drug. The apparent widespread availability, access, and abuse of such potent steroids are a cause of concern in developing countries. We suggest that physicians in the United States be aware of the potential abuse of such potent drugs in all populations, including immigrants.
authors.affiliation: Department of Medicine, University of Washington, Seattle, USA.
authors.forename: S
authors.initials: S
authors.lastname: Quddusi
authors.forename: P
authors.initials: P
authors.lastname: Browne
authors.forename: B
authors.initials: B
authors.lastname: Toivola
authors.forename: I B
authors.initials: IB
authors.lastname: Hirsch
mesh_terms: D001249:Asthma / Q000188:drug therapy; D001623:Betamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D003480:Cushing Syndrome / Q000139:chemically induced* / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D012651:Self Medication / Q000009:adverse effects*
chemical_list: C028994:betamethasone sodium phosphate; D001623:Betamethasone